Anatomy Tutorial: Frontal Chest X-Ray

Introduction

• Focus: Anatomy of frontal chest x-ray
• Common in practice and exams
• Not an approach to chest x-rays, just anatomy

Approach to Chest X-Ray

• Contours and Lines: Identify normal structures and abnormalities

Mediastinum

• Left Side:

  • Left subclavian artery from aortic arch
  • Aortic knuckle/Aortic Arch
  • Pulmonary trunk and AP window (aorto-pulmonary window)
  • Left atrial appendage and left ventricle

• CT Scan Reference: Arch of aorta, left subclavian artery, pulmonary trunk, left atrium

• Right Side:

  • Right atrium forms right heart border
  • Superior vena cava and brachiocephalic veins
  • Cable atrial junction (tip of central venous line)

• Coronal Slice Reference: Superior vena cava, right atrium

Lines and Stripes

• Lines:
  • Posterior Junctional Line: behind trachea
  • Anterior Junctional Line: below manubrium
  • Asygoesophageal line/recess: Azygous vein and esophagus
• Stripes:
  • Left and right paratracheal stripes
  • Paravertebral lines

Airways

• Trachea and Bronchi:
  • Trachea bifurcation into right and left main bronchus
  • Bronchopulmonary tree: Right upper/middle/lower lobe bronchi, left upper/lower lobe bronchi
• CT Scan View: Shows bronchial structure, aspiration patterns

Hilum

• Right Hilum:
  • Right pulmonary artery, right interlobar artery
  • Superior pulmonary vein
• Left Hilum:
  • Left pulmonary artery wraps over left main bronchus
  • Left interlobar artery, superior branches
• CT Scan Visualization: Understand path of pulmonary arteries

Lobes of Lungs

• Right Lung: 3 lobes
• Left Lung: 2 lobes
• Fissures:
  • Horizontal fissure (right lung)
  • Oblique fissure (both lungs)

Diaphragm

• Right diaphragm higher due to liver
• Openings:
  • Aortic (T12)
  • Esophageal (T10)
  • Vena caval (T8)

Pleura

• Look for pleural effusions, thickening, pneumothorax

Bones

• Structures:
  • Vertebral column, ribs, clavicles, spine
  • Shoulder and humeral head
• Areas to Check: Ribs for fractures, posterior areas for masses

Soft Tissues

• Check: Above clavicles, axilla, soft tissue masses
• Considerations: Female breast tissue

Conclusion

• Importance of systematic approach to chest x-rays
• Look for anatomy: mediastinal contours, lines, stripes, airways, hilum, heart, bones, soft tissues, pleura, diaphragm
• Aim: Identify pathology efficiently

Final Note

• Encouragement to develop a systematic approach for thorough examination.